Healthcare Provider Details

I. General information

NPI: 1639103955
Provider Name (Legal Business Name): THOMAS GERARD GUGLIELMO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 KENT RD
NEW MILFORD CT
06776-3485
US

IV. Provider business mailing address

131 KENT RD
NEW MILFORD CT
06776-3485
US

V. Phone/Fax

Practice location:
  • Phone: 860-354-8616
  • Fax: 860-354-0473
Mailing address:
  • Phone: 860-354-8616
  • Fax: 860-354-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00676
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: